A slipped disc is a common problem that can cause back or neck pain, and can lead to a trapped nerve or sciatica.
Other names for a slipped disc include bulging disc, herniated disc and prolapsed disc. Healthcare professionals usually use the term disc degeneration to cover all of these names.
Pain from a slipped disc can come on gradually or suddenly, and can occur after even the gentlest of activities.
A slipped disc can cause minor discomfort or unbearable pain. Surprisingly, the amount of pain does not correlate with the severity of disc bulging.
Diagnosis is usually made following physical and neurological examination and treatment usually involves exercise and manual therapy.
Slipped discs are rarely serious and almost always respond very well to conservative treatment.
Interestingly, 37% of pain-free 20 year olds have visible disc degeneration when scanned.
The symptoms you might experience if you have a slipped disc are dependant on where in your spine the problem is, and whether any nerve tissue are involved.
Typically, people with a slipped disc will experience lower back pain or neck pain, which can be mild through to very severe.
People with a slipped disc often experience muscle spasm as well, with muscles close to the spine contracting firmly and causing localised pain and limited range of motion. You may feel as though you are unable to straighten up or are being pulled into an abnormal posture.
If nerve tissue is involved, you may have pain, numbness or pins and needles travelling down your leg or arm. You may also experience weakness of muscle in your leg or arm in some instances.
Discs are soft balls of jelly encased in a tough, fibrous capsule located in-between each segment of your spine.
Without discs your spine would be one solid block of bone, and so the role of discs is to allow your spine a limited amount of movement.
Too much movement, or additional loading through poor posture, can cause discs to deteriorate. The most common cause of this deterioration is repeated or sustained forward bending of the spine.
When you bend forward your discs are slightly squashed, but this ok because they are elastic and will pop back into their proper shape as soon as load is removed.
However, repeated squashing, or being squashed for a long period, causes discs to lose some of their elasticity. Eventually, a disc will lose its ability to pop back into shape.
The new shape of the disc will be slightly flatter and more spread out. This could be called a bulging disc. It is unusual for this to be painful.
While not necessarily painful, a bulging disc does make you slightly more vulnerable to getting back pain and sciatica.
Because the disc is slightly more spread out, it narrows some of the spaces that your nerves travel through. This means that your nerves can come into contact with the disc when you are moving around.
Contact between nerve tissue and discs can cause the nerve to become excited, leading to pain, pins and needles, numbness and other sensations along the course of the nerve.
When a nerve is stimulated in this way, muscles in your back will often contract to stop you moving that part of your spine.
This muscle contraction can be extremely painful. Often there is some accompanying inflammation, or swelling, which is also painful.
If a disc is severely squashed, it means that part of your spine is less supported. This makes you more vulnerable to other causes of back pain such as joint irritation.
It is important to know that even if pain comes on very suddenly there is not likely to have been any sudden deterioration of the discs in your spine, this process takes years.
The reason for sudden pain is usually a combination of nerve and joint irritation with local muscle spasm.
Self-help options for slipped discs are very similar to those for other causes of back pain.
The keys are to remain as active as possible and to try to reduce inflammation.
Over the counter medication such as ibuprofen is usually very effective at reducing inflammation and decreasing the severity of your symptoms. Ice packs are also useful for the same reason.
If you have stomach problems, heart problems or are on other medication, discuss this with your pharmacist before taking anti-inflammatories.
Some people report relief from using heat packs and, while these do not assist in decreasing inflammation, there is no harm to be found in trying a heat pad to see if helps you.
General activity such as walking and swimming are amongst the best things to do if you have a slipped disc.
While activity in general is very helpful, you should consult a chiropractor before attempting any stretches or specific exercises.
Topical gels and rubs have little proven efficacy for helping with a slipped disc, but can be worth a try.
If you have back pain, neck pain or suspect you may have a slipped disc, a chiropractor can examine you and explain the source of your pain. A chiropractor should also be able to provide effective treatment to help relieve your symptoms.
As well as helping to speed your recovery, a chiropractor can also advise what exercises and lifestyle modifications you can make to avoid recurrence.
You do not need to wait to make an appointment, although if you are in severe pain it can be helpful to wait until painkillers have kicked in.
Counterintuitively, instead of masking the problem, painkillers can make it easier to carry out full physical examination, helping your chiropractor properly diagnose the cause of your pain.
There are some times when patients with slipped disc should not see a chiropractor. If you have any of the following your GP is more likely to be able to help:
- Saddle Anaesthesia – lack of feeling around your bottom, genitals or inner thighs.
- Bowel or bladder changes – eg. faecal incontinence, urinary retention
Most people think that a scan is essential to diagnose a slipped disc, but for several reasons this is not the case.
For one, having a slipped disc does not mean you will have pain. It is very common that people are shown to have slipped discs even when they have never had back pain. So we shouldn’t really be diagnosing you as having a slipped disc.
Secondly, finding a slipped disc on MRI when you are in pain can lead to the assumption it is the disc that is causing your pain, making it possible to overlook other causes. This happens much more often than you might think, and leads to unnecessary and often invasive treatment.
Another, very important, reason why MRI should not be used if you suspect you have a slipped disc is that it can lead to anxiety about the condition of your spine.
If you are in a lot of pain and find out you have three bulging discs you might behave differently to if you did not have this information. And since disc degeneration is as common and as important as wrinkles, this is unnecessary anxiety.
The preferred method of diagnosis when you suspect you have a slipped disc, therefore, is physical examination.
Physical examination reveals how you are loading your spine and which areas need to function better to relieve your pain, rather than just what you look like under the skin.
Treatment for a slipped disc is slightly misleading, since strictly speaking slipped discs don’t need treating at all.
But when we talk about treating a slipped disc, we mean treating the symptoms that may be associated with a bulging or degenerative disc.
As already touched upon, these symptoms can come from a number of tissues, and which tissues are involved can vary from person to person.
Therefore, treatment and rehabilitation should be tailored to each individual and should be based on findings from physical examination.
Broadly speaking, treatment should follow a similar pattern to that used when dealing with other types of lower back pain.
This should include:
- Increasing activity levels
- Manual therapy
- Over-the-counter anti-inflammatories
- Specific rehabilitative exercises
Acupuncture alone is not thought to be very helpful for low back pain or pain associated with slipped discs, but can be helpful alongside manual therapy and exercise.
In very rare instances, some patients will not respond to conservative treatment. In these instances it is always worth seeking a second opinion, since the symptoms from a slipped disc can mimic other problems.
If you have followed a conservative treatment approach for six months and have not significantly improved you may be a candidate for more invasive treatment approaches.
The first of these is a spinal injection. This is a strong anti-inflammatory, coupled with an anaesthetic, which decreases the sensitivity of pain-generating tissues in your back.
Injections have good results in terms or relieving pain, but do carry greater risks than conservative options. These include infection, nerve injury and osteonecrosis.
Surgical options for slipped discs are now strongly discouraged because of poor risk-benefit ratios.
If you have had a slipped disc before, you are at greater risk of having a similar problem again. This is true even if you follow all the best advice. But the risk of pain recurring can be dramatically reduced.
Proper rehabilitation, involving strengthening of core muscles, is the best strategy for preventing pain returning. Different people need to strengthen different muscles, so advice is helpful to make your rehabilitation as efficient as possible.
Increasing your level of general activity has also been shown to be very helpful at reducing your risk of sciatica and lower back pain. Walking more and sitting less is incredibly powerful.
Manual therapy has been shown to be helpful in reducing the recurrence of sciatica and lower back pain, helping maintain your body’s proper function.